In England and Wales, births fell to 591,072 in 2023, the lowest number since 1977, and the fertility rate dropped to 1.44 children per woman. That shift is putting more women into postpartum recovery and perimenopause at the same time, creating a care gap where overlapping symptoms can be missed.
The NHS says menopause and perimenopause usually affect women between 45 and 55, but they can happen earlier. Its symptom guidance lists hot flushes, period changes and mood changes, while NICE says menopause-associated symptoms in people aged 45 and over can be identified clinically when vasomotor symptoms have recently started and menstrual patterns change. That matters because the NHS says postnatal depression can begin while pregnant, soon after birth, or up to a year after a baby is born, with anxiety, irritability, sleep problems and trouble concentrating among the signs.
The problem is that the two stages share a lot of the same language. Sleep disruption, low mood, irritability, low libido, night sweats and hot flushes can all be written off as ordinary new-parent exhaustion when they may also point to a midlife hormone shift. For women giving birth later, that makes it easier for perimenopause to be overlooked while maternity services are still treating the body as if it is only in the postnatal window.
Breastfeeding can make the picture harder still. The Breastfeeding Network says it is possible to be perimenopausal while breastfeeding and that postnatal and perimenopausal symptoms can be difficult to tell apart. For women in their early 40s, that low-oestrogen state can blur the line between recovery after birth and the first stage of the menopause transition.
The British Menopause Society is the UK specialist authority for menopause and post-reproductive health, but the system still tends to separate maternity care from midlife women’s health. The Women and Equalities Committee has said many women experience reproductive health symptoms being dismissed or normalised, and the UK government has said early intervention is crucial to stop conditions worsening. Women with persistent mood change, sleep loss, night sweats, irregular bleeding or other ongoing symptoms after birth should raise both postpartum and perimenopausal possibilities with their GP, because “normal new-mum tiredness” is not a safe clinical endpoint.